No abstract

Background: The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of the work was to investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery. Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to January 2021 by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were randomized according to EML incision closure technique into group A without SCSD and group B with closure of EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia. Results: Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise, the duration of hospital stay was significantly shorter among patients in group B versus those in group A. Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of duodenal ulcer in group B. After a median follow-up of 26 (range: 7 -44) months, the protective effect of SCSD against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during closure of non-traumatic EML.

Lower limb reconstruction remains a big concern. Great advancements have been made over the past century for reconstructing traumatic and non-traumatic defects in leg and foot. The reconstructive methods ranged from leaving the wound to heal by secondary intention up to free flap. Large defects are commonly reconstructed with free fasciocutaneous flaps or free muscle flaps with skin grafts. The result of a reconstructive operation is mainly due to the vascular component's stability, which is crucial in ensuring the flap survival and proper function. The lower extremity has also been recognized for slow wound healing and as an inadequate source of the flap for reconstruction. In this study, we will present our experience in sohag university hospital In free Antero Lateral Thigh flap used in leg and foot reconstruction as regarding flap outcome, complications.

Background: Enucleation of pancreatic benign lesions and borderline tumors, compared with standard pancreatic resection, may avoid postoperative impairment of the metabolic pancreatic functions. However, its influence on postoperative morbidity and disease recurrence seems obscure. Therefore, the choice between both approaches remains controversial.Objective: To evaluate the outcome of enucleation compared with standard pancreatic resection (SPR) of pancreatic benign lesions and borderline tumors among patients presented to Sohag University Hospital. Patients and Methods: Adult patients who underwent enucleation (group A) versus standard resections (group B) of pancreatic benign lesions and borderline tumors at Sohag University Hospital (June 2017 -May 2021) were prospectively enrolled. Both surgical techniques were compared regarding their influence on postoperative metabolic functions of the pancreas, surgical complications, and disease recurrence. Results: Sixteen patients (eight per group) with comparable gender and age distribution were eligible. Group A had significantly shorter operative time, lower amounts of intra-operative blood loss and less transfusions compared to group B. Likewise, patients in group A exhibited significantly reduced severity of surgical complications, including postoperative pancreatic fistula, and required significantly shorter periods of hospital stay. The incidence of new onset diabetes mellitus and pancreatic exocrine insuffficiency were significantly lower among patients in group A compared with those in group B. During follow-up, no recurrence was found in both groups. Conclusion: It could be concluded that enucleation of pancreatic benign lesions and borderline tumors preserves pancreatic metabolic functions, reduces postoperative morbidity and confers satisfactory oncologic outcome.

Background: Rectal carcinoma constitutes a health problem, previously managed with abdomino-perineal resection (APR) which has the impact of poor patient quality of life. With the introduction of the concept of total mesorectal excision (TME) and stapler technology, sphincter saving surgery (SSS) with its better local control and functional status is a better choice than APR. We tried to evaluate the operative safety, long-term oncologic and functional outcomes of SSS in rectal carcinoma.Patients and methods: Between October 2008 and October 2012, patients with rectal carcinoma who presented electively to Sohag University Hospital underwent SSS based on sharp mesorectal excision in the form of anterior resection, low anterior resection and intersphincteric resection were evaluated. Patients were followed up for four years.Results: A total of 60 patients underwent SSS, regarding operative complications; there were 2 ureteric injuries and one bladder injury. Postoperatively, anastomotic leakage occurred in 6.7% of cases. Local recurrence and distant metastases were detected in 8.3% 13.3% respectively. During follow-up, disease-free survival rate was 66.9%, overall survival rate was 93%, 22% of patients had a degree of incontinence. 21.66% had temporary bladder dysfunction. Sexual dysfunction became evident in 30% of male patients. Conclusion:SSS with TME provides a better alternative to APR in rectal carcinoma when feasible.